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Coronavirus ‘Effectively Eliminated’ in New Zealand Due to Comprehensive Approach of Government

Julia Conley

Five weeks after launching an aggressive nationwide lockdown to combat the coronavirus pandemic—coupled with one of the most robust economic relief packages of any country—New Zealand’s government on Monday announced that the new coronavirus is currently “eliminated” in the nation.

The country’s Prime Minister Jacinda Ardern said Monday that while cases are not at zero, new cases have been in the single digits for the past several days—an “incredible” statistic, said Ardern, as other countries face thousands of new cases per day.

“We have done what very few countries have been able to do,” Ardern said last week as the country was preparing to move from a Level 4 restrictions to Level 3, allowing some businesses to reopen. “We have stopped a wave of devastation.”

One new case was reported Monday, as well as four “probable cases” and one new death.

“We’ve achieved our goal of elimination… That never meant zero but it does mean we know where our cases are coming from,” Director General of Health Ashley Bloomfield said.

As the country reduces restrictions to Level 3, businesses that reopen will be required to maintain physical distancing rules. Schools will reopen with limited capacity, and workers will still be encouraged to work from home if they are able to. Events such as weddings and funerals will only be able to take place with up to 10 people in attendance, and public buildings such as museums, libraries, and gyms will remain shuttered for the time being.

New Zealand has confirmed a total of 1,469 cases of COVID-19, the disease caused by the new coronavirus, since the first case there was detected on February 28.

In New Zealand, home to 4.8 million, the disease has infected about 30 in every 100,000 people and has killed 19 people—fewer than one in every 100,000 people.

The numbers in the island nation contrast sharply with those in the U.S., where nearly one million people have been sickened—nearly 300 in every 100,000—and more than 50,000 people have died.

Ardern has been credited with enforcing a strict lockdown even before the disease had claimed any lives in New Zealand. Two weeks after the first case was reported, the prime minister ordered anyone entering the country to self-quarantine for 14 days. Most businesses shut down on March 23, when there were 102 cases and no deaths, and the country began enforcing Level 4 restrictons—forbidding people to leave home except for outdoor exercise nearby—on March 25.

Ardern’s extreme measures were in line with the recommendations of top public health officials, including U.S. National Institutes of Health Director Francis Collins, who said last month that the measures most effective at slowing the outbreak would likely be seen as “too drastic” by many.

New Zealand has also been testing the public at one of the highest rates in the world, Ardern said Monday, administering nearly 124,000 tests in recent weeks with the capacity to complete 8,000 tests per day. The U.S. has increased its testing capacity in the past month, but public health experts say the severe lag in confronting the pandemic in the U.S. after the first case was reported there in January has made the disease difficult to contain.

On social media, observers noted the stark contrast between the two countries’ approaches, with government watchdog Public Citizen saying the United States’ response has been marked by the “unending incompetence” of the Trump administration.

New Zealand paired its orders for the country to stay at home for five weeks with a major relief package amounting to about 4% of the country’s GDP—a far more significant spending plan than other wealthy countries.

The government covered wages for all New Zealanders who had to self-isolate but couldn’t work from home or were caring for sick family members. Businesses were also offered subsidies to continue paying employees, and the government doubled its healthcare spending.

Public health agencies were given resources for contact-tracing to determine who ill people could have potentially spread the disease to, which hospitals received support to increase intensive care units.

“This package is one of the largest in the world on a per capita basis,” Grant Robertson, New Zealand’s finance minister, said in March as the package was announced.

Meanwhile in the U.S., President Donald Trump has largely left it up to states to determine how to approach lockdowns, and several states have begun reopening their economies—even though the testing rate in the U.S. is lower than New Zealand’s and thousands of new cases are being reported per day.

“The earlier and more decisively governments acted, the sooner they can responsibly ease their lockdowns,” columnist George Monbiot tweeted. “Unlike New Zealand’s and South Korea’s, our government dithered and delayed. As a result, we’re now in a terrible mess.”

(Julia Conley is staff writer for Common Dreams, a US non-profit news portal.)

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Sweden’s Flawed Coronavirus Battle Plan Results in Worst Death Count Among Nordic Countries

Marcello Ferrada de Noli, April 10, 2020

In only three days, the total fatalities in Sweden due to the current epidemic rose from 477 to 881. While the problem started roughly about the same time in all the Scandinavian countries, Sweden’s stats are among the worst.

Sweden has not only the highest rate of fatalities per capita, but also the total death toll is higher than that of all the other Nordic countries put together. As of April 10, Sweden has 86 Covid-19 fatalities per one million of population, while Finland has nine, Norway 20, and Denmark 43. (The U.S. has 47, and Russia 0.5 Covid-19 fatalities per one million, respectively).

The elderly and the poor

The authorities have been repeating for weeks that the paramount aim of their strategy is to protect the elderly. But 40 percent of all victims were infected in homes housing them. And while no testing has been provided to the personnel taking care of these elderly, the virus has reached one third of Stockholm nursing homes. The vast majority of Covid-19 deaths in Sweden corresponds to people aged over 70.

Furthermore, areas in the Stockholm region inhabited mainly by immigrants with lower socioeconomic status are overrepresented among those infected by the virus. It is the worst in Rinkeby-Kista (the suburb referred to by Trump in his renowned quote “Look what happened last night in Sweden”) which exhibits the highest rate per capita (48 per 10,000). In social-privileged areas, e.g. Kungsholmen, it is only nine cases per 10,000. On March 16, an independent organization of Somali physicians revealed that at least six out of 15 fatalities that occurred in Stockholm were of Somali origin.

Further measures detrimental to the elderly’s odds partly consist in new instructions to doctors as to how to prioritize the selection of patients to be treated in intensive care units. Clearly, patients of a biological age 8o or over should not be prioritized. The same regarding people 70-80 years old who have a significant disease in more than one organ system. Neither should people aged 60-70 who have similar failure in more than two organ systems be eligible for intensive care.

The above rules are to be applied in situations where there are not enough critical beds. But even if the authorities have now made efforts to increase bed availability, Sweden was, according to EU statistics, the country in Europe with the lowest number of curative care beds in hospitals. Local mainstream media reported that during the 90s Sweden dismantled most parts of their field hospitals which had been kept in case of major catastrophes. Other measures affecting the elderly is that all planned operations (e.g. cancer, etc.) have been canceled. The number of operations decreased by five thousand during the previous week alone.

Swedes are not inherently special

As declared by the government and public health authorities, a key component in the Swedish strategy would be some national idiosyncratic factor making Swedes abide by the authorities’ leadership, i.e., “authorities only need to recommend, people follow.” Sweden’s Foreign Minister Ann Linde explained on March 30 that Swedes have “a lot of trust” in each other and in the authorities and politicians, and that the public follows the decisions and takes personal responsibility. She repeated on April 9:

“We trust that people take responsibility.”

Put aside Swedish author Elisabeth Asbrink’s explanation that the often echoed “trust” could instead be “naivety, or passivity, or laziness, or even despise for the elderly,” what Minister Linde said is empirically questionable in the context of this epidemic.

Newspaper DN published the results of a survey carried out on April 9 among the Swedish people which focused on the attitudes of the public regarding “social distancing”–a cornerstone in the authorities’ recommendations. The survey results show that–paradoxically–despite the authorities’ calls for “social distancing” having successively sharpened, less and less of the people interviewed over a number of days were in favor of abiding with the recommendations.

The study then names the age-groups which “to a greater extent break the recommendations of the Public Health Agency.” It also concludes that such,

“national behavior (riksbeteende) indicates that–with great probability–the infection shall increase in the coming days.”

To assess the injury-epidemiological consequences of the Swedish strategy is also difficult due to unreliable statistics. On the one hand, the reported “infected cases” is solely based on tested cases, chiefly done only at hospitals; the real number of Swedish cases remains unknown. On the other hand, the death toll reported on a daily basis does not represent the real number of fatalities of that day, as the Public Health Agency claims they receive scores of death reports days after deaths occurred.

In addition, according to a Swedish associate professor in anaesthesiology and intensive care, Dr  Mats Eriksson, “Numerous patients released from hospitals then die at home, untested, and get the diagnosis of unspecified pneumonia.”  He also noted,

“There is an instruction in Stockholm that suspicious deaths caused by Covid-19 shall not be further tested and therefore not included in the statistics. Yet, they should be put in a death-bag marked ‘Infected.’”

The Swedish experiment is flawed. Either it’s not emphatically true that Swedes are so voluntarily obedient or the recommendations from the authorities are considerably insufficient–besides being non-coercive. The drastic increasing death toll in comparison to neighbouring countries speaks volumes..

(Marcello Ferrada de Noli is Swedish professor emeritus of public health sciences, esp. epidemiology, and former research fellow at Harvard Medical School.)

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This Japanese Island Lifted Its Coronavirus Lockdown Too Soon and Became a Warning to the World

Abigail Leonard, April 24, 2020

Japan’s northern island of Hokkaido offers a grim lesson in the next phase of the battle against COVID-19. It acted quickly and contained an early outbreak of the coronavirus with a 3-week lockdown. But, when the governor lifted restrictions, a second wave of infections hit even harder. Twenty-six days later, the island was forced back into lockdown.

A doctor who helped coordinate the government response says he wishes they’d done things differently. “Now I regret it, we should not have lifted the first state of emergency,” Dr. Kiyoshi Nagase, chairman of the Hokkaido Medical Association, tells TIME.

Hokkaido’s story is a sobering reality check for leaders across the world as they consider easing coronavirus lockdowns: Experts say restrictions were lifted too quickly and too soon because of pressure from local businesses, coupled with a false sense of security in its declining infection rate.

The Japanese prefecture of 5.3 million people, known for its rugged mountain beauty and long history of farming and fishing, was the first area of Japan to see a major coronavirus outbreak. It’s very different from Japan’s main island, Honshu, with its frenetic sprawling cities. And its response to COVID-19 has also been very different. Hokkaido’s leaders acted early and decisively, even as the national government was criticized for moving too slowly to stop the spread elsewhere. Japan still has relatively few confirmed COVID-19 cases compared to other countries—12,400—but the numbers have more than doubled in the last two weeks, alarming international health officials.

Early action

Hokkaido’s story starts Jan. 31, at the annual snow festival in the island’s capital city of Sapporo. More than 2 million people attended the wintry carnival, to marvel at giant ice sculptures and dine on crab hotpot. Many were Chinese tourists, on vacation for the Lunar New Year.

Around the start of the festival, Hokkaido doctors saw their first coronavirus patient, a woman from Wuhan, China. Then several more Chinese tourists fell ill and soon the virus was circulating in the general population.

On Feb. 28, exactly a month after the first case was reported, there were 66 cases, the highest of any prefecture in Japan, and infections were accelerating, so the governor declared a state of emergency. At a press conference at the time, Nagase praised the government’s fast response and said it could be a model for the country.

Schools closed, as did many restaurants and businesses, even though they weren’t legally compelled to shut. In Japan, the government can’t use police or military to enforce a lockdown, it can only ask—and in some cases beg—businesses to close. That’s in part because the country’s constitution, written after the Second World War with the help of the Americans, has strict protections for civil liberties in order to avoid a return to fascism.

Mostly though, people complied. “Hokkaido residents are pretty obedient, plus it’s cold that time of year, so people usually lock themselves inside with a hot water heater anyway,” said Yoshfumi Tokosumi, a former editor for the Hokkaido Shimbun newspaper.

False sense of security

By mid-March, the health crisis was stabilizing—new cases were in the low single digits and even zero on some days—but complaints from businesses were increasing.

Hokkaido’s two main industries—agriculture and tourism—had been devastated. Farmers watched produce rot because restaurants and school lunch programs stopped buying it. An estimated 50 food processing companies went bankrupt. And Hokkaido’s dairy industry was hit so hard that the Ministry of Agriculture launched a video campaign featuring a ministry official dressed as a cow, to encourage people to drink more milk.

Similarly, tourism was decimated by travel restrictions and the state of emergency measures. In Kutchan, a resort area that gets more snow than almost anywhere else on Earth, skiers and other tourists vanished, says Mayor Kazushi Monji. “We’ve seen almost no new hotel reservations since the state of emergency was declared and the damage to small businesses has been severe.”

In March, Hokkaido Governor Naomichi Suzuki grappled with whether to maintain the lockdown and endure more economic pain, or lift it and risk the health consequences. Suzuki is a popular figure, with a nearly 90% approval rating.

On March 18, Suzuki assembled his advisers and decided it was time to ease restrictions. Nagase, the doctor who helped coordinate the government’s response, says that at that time, officials had only a limited understanding of the virus and how quickly it could spread. “Hokkaido was the first big outbreak here, so we were really operating in the dark.” Without sufficient data, doctors based their recommendations on the idea that the coronavirus spread like influenza. Nagase says he now regrets not pushing for more testing from the beginning.

The next day, the governor announced he would lift the state of emergency, but asked residents to continue to restrict social interaction and stay home if they felt unwell. He also said Hokkaido would keep 34 government-run facilities closed, as well as many schools. He called it “The Hokkaido Model,” in which residents would work to prevent infection while still continuing social and economic activities.

Second wave is bigger than the first

The announcement lifting restrictions came just before a three-day weekend; Hokkaido residents spilled onto streets and lingered in cafes, celebrating the conclusion of their weeks-long confinement. That likely kicked off the second wave of infections, says Nagase.

Further fueling it, people from other parts of Japan saw that Hokkaido had relaxed restrictions and began travelling there. Some were university students in big cities, who returned home to Hokkaido when classes were cancelled in April, says Nagase. Others were employees of large companies that typically start new job rotations at that time of year; when the state of emergency was lifted, businesses sent a fresh crop of workers from Tokyo and Osaka to Hokkaido.

That likely seeded even more infections and soon the second outbreak was in full bloom. By April 9—exactly three weeks after the lockdown was lifted—there was a record number of new cases: 18 in one day. “Officials thought about people coming from overseas but never considered that domestic migration could bring the virus back,” said Hironori Sasada, professor of Japanese politics at Hokkaido University.

On April 14, Hokkaido was forced to announce a state of emergency for a second time. The island had 279 reported cases, an increase of about 80% from when the governor lifted the first lockdown less than a month before. As of Wednesday, there were 495 cases in Hokkaido.

Nagase worries that Japan as a whole has not learned from Hokkaido’s mistakes, though. “I’m on the board of the Japan Medical Association and we’ve been pushing the central government for stronger national measures, but it comes back to the economy: because of the economic situation, it’s really hard to lock down in Japan.”

Prime Minister Shinzo Abe did announce a state of emergency on April 7 for seven prefectures, but did not include Hokkaido. On April 16, he extended it nationwide, noting that the virus was spreading as people moved between prefectures. In early May, the country will celebrate one of its biggest holidays of the year, Golden Week, when people typically travel around the country on vacation. National officials have advised people to stay put and Suzuki, the Hokkaido governor, has warned against non-essential outings.

As for Nagase, the doctor involved in Hokkaido’s response, the hard lesson he and the prefecture have learned, he says, is that until there’s a vaccine or medicine, everyone has to take personal responsibility and understand that, “it really may not be until next year that we can safely lift these lockdowns.”